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This spring, Judy Zager, RN at NorthShore, and Ken Fox, MD, Pediatrician at NorthShore, joined a team of Chicago-area healthcare volunteers
in Panama. The team traveled to a remote area of Western Panama to provide much needed healthcare to those with limited access, including individuals from one of the country’s last remaining indigenous tribes, the Ngobe-Bugle.

Judy Zager tells us
about the impact she made and the lasting impact the experience made on her.

Why did you choose Panama for your first medical mission trip?
A friend of mine was instrumental in building the dental clinic at this particular site. He’d asked repeatedly for me to join him on a mission. Once I made the commitment, I was asked to recruit a pediatrician and Dr. Fox readily accepted the invitation.

What were your expectations before you left?
My only expectation was that we would be seeing many people who would travel very far distances for care. When I spoke with another nurse who had been at the site on other missions, she explained what I should expect to see. It was useful to talk to her beforehand.
Her information was a helpful “heads up” for what to anticipate.

What was a “typical” day at the clinic like?
A typical day started at about 9:00 AM. Our arrival was announced on the radio. The patients we saw walked far for care and came early. They often had to wait hours for their number to be called. With the assistance of Ngobe and Spanish interpreters, each
person was triaged prior to being seen by the physician. Vitals were established and their complaints, along with symptoms, were documented. After that, they were evaluated by Dr. Fox and tested when appropriate for pregnancy or strep. Medication that had
been donated to this project was distributed when appropriate.

Was there a case that made an impact on you?
There was a mother and her sister who walked four miles with twins. The twins had an advanced case of impetigo, which is a highly contagious bacterial skin infection common among younger children. This particular case was so advanced that one twin had developed
cellulites and the other required IV antibiotic treatment. The minister in charge of our program facilitated getting them admitted to the local hospital.

Why is mission work like this so important for you?I stepped outside my comfort zone to travel to another country to provide care for others. I did begin to second guess myself once I had made the commitment to go. Why was I giving up my vacation time and spending my own money to do this work? In
the end, it was more rewarding than I ever could ever have imagined.

What did you take away from your experience? Will you do this again?
The work environment was primitive. The friend who recruited me helped build the dental clinic and it is a beautiful dental facility that’s very easy to work in. We (me and Dr. Fox) were in a makeshift area. It was oppressive in the heat with minimal ventilation
and just a couple ceiling fans. There was also no running water. I came home inspired to return but also inspired to help raise funds to make the medical clinic a better place to work and a better place to receive care.

This spring,
Ken Fox, MD, Pediatrician at NorthShore, and Judy Zager, RN at NorthShore, joined a team of Chicago-area healthcare volunteers in Panama. The team traveled to a remote area of Western Panama to provide much needed healthcare to those with limited access,
including individuals from one of the country’s last remaining indigenous tribes, the Ngobe-Bugle.

In part one of this two part series, Dr. Fox shares some of the most memorable moments and tells us why this wasn’t his first and certainly won’t be his last medical mission trip.

Was this your first mission trip?No. I was in Haiti for a week one month after the earthquake of 2010. And I’ve done work in Cape Town, South Africa as well.

Why are you drawn to this type of medical mission work?I’ve always been drawn to other cultures and customs. And as a pediatrician, I’m fascinated by the varieties of ways that families and communities come together to do the work of caring for children’s health. My previous work in medical anthropology
combined these interests to help inform my clinical work. This Panama trip was an opportunity to rekindle a kind of “vitality of practice” I hold dear.

Prior to leaving on this trip, what were you expecting? How closely did your experience match your expectations?I wasn’t absolutely sure what to expect. Before we left, I read some on Panamanian history, society and indigenous cultures. And I even read some fiction by a contemporary Panamanian writer. What you learn in books is one thing; being out there on
the frontline in the heat and the dust among people struggling to survive with very limited resources is something else entirely.

The abject poverty and absence of resources—poor transportation, housing, nutrition, scarcity of potable water, poor sanitation, low educational/literacy levels, inadequate clothing and shoes—create a perfect storm of risk for the people we served on this
mission.

Describe a “typical” day at the clinic? What were some of the most common illnesses you helped treat?We usually arrived about 9 AM to find a courtyard full of waiting patients. Most of them had walked for hours to get there. We often worked in three languages (Ngobe, Spanish and English). Recruiting all the clinical acumen we had to muster, we tried
to figure out quickly and efficiently what was most at stake. Our focus was to address their questions as best we could. There was no lab, x-ray or subspecialist to consult. We had to think on our feet, use our physical exam skills and make decisions.

In this setting, the power of social forces to shape health and illness was so apparent. We had to be mindful of resource constraints and be creative in seeking solutions. But on a deeper level, the moral dimensions and “doctoring” were so much easier to
see. It was all very challenging but often very gratifying.

Was there a single case that had the most impact on you? The most memorable case was a pair of two-year-old twins who showed up one morning with their mom and aunt. They heard a radio broadcast about the medical care available at the community center and walked four hours from the mountains to get to us.

They had the worst case of bullous impetigo and ear cellulitis I’ve ever seen. The ear of one was just macerated and covered with sores and pus. Then we brushed back the other twin’s thick black hair to find a similar infection on her forehead. Wcleaned
things up and decided to contact a Panamanian colleague with hospital privileges to get them admitted for IV antibiotics. We texted a picture and he arranged for admission to the closest hospital which was about an hour away. It just so happened that someone
was delivering supplies to the site by truck at that moment. Since there is no ambulance service available, we arranged for him to drive the family to the hospital. I will never forget the sad sight of this mom climbing into the back of a truck with a twin
tucked under each arm heading for the hospital. How difficult it must have been to face such uncertainty and threat. She’d already struggled to get to us, but she was relieved to get help.

How a simple skin infection we see here every day gets transformed into such a severe illness is a reflection of the “structural violence” some people are forced to endure. It just doesn’t seem fair or necessary in a nation in the midst of a vast economic
expansion with a 10.5% annual GDP growth rate. The experience just reminds me of the power of social inequalities to harm health—a truth evident here at home as well.

How will work like this help make you a better doctor?It’s always healthy to have experiences that remind you of the fundamental reasons you go into a “helping profession” like medicine in the first place. The daily grind of primary care can sometimes dull the acute sense of purpose that enlivens our
work. Patients are not customers—our work adds up to more. There’s something special about the relationships we form—something sacred—if we’re given the space to do the work.

Where were the other medical professionals from? How many were on this trip?The trip was organized by a prominent Chicago dentist and his wife who built a fantastic dental clinic in the community. They worked in collaboration with an American
expat pastor who has longstanding relationships among the Ngobe community in Panama. They’ve done a number of impressive projects together over the years. NorthShore nurse Judy Zager and I joined them on this trip.

Do you think you will do something like this again?
Absolutely! I learned a lot about humanitarian medical relief efforts and community medicine in resource poor settings. And I want to try to build this kind of experience on a regular basis into my ongoing professional work and development.

I was so grateful to my colleagues here at NorthShore. People were interested in what we were doing and so supportive, from covering our patients and on call duties while we were gone to donating books and other materials for the trip. People had our backs.
And that means the world to me.

In part two, Judy Zager will tell us about her experience on this medical mission to Panama.

Summer has arrived. Ice cold glasses of lemonade and cookouts are among the many perks of the warmer weather. But don’t forget to add the
delicious fruits, vegetables and herbs in season during the summer to that list. Sure, it’s easy to find produce at your local grocery store, but when you grow it yourself, you reap both the nutritional and physical benefits of your harvest.

Geeta Maker-Clark, MD, Integrative and Family Medicine at NorthShore, shares some of the benefits gardening can have on your overall
health:

Pesticide and preservative free. Homegrown produce and herbs mean you know exactly what went into the growth and harvesting of your food. You can rest assured that there are no unnecessary preservatives and/or pesticides.

Encourages healthy eating habits. Knowing that the food on your table is a direct result of your hard work can help you make smarter food choices. It might also encourage you to include more fruits and vegetables in your daily meals. You
may end up growing some varieties of veggies and fruits that you have never tried before.

Saves some green. Keeping an edible garden reduces the amount of produce you have to buy at the grocery store.

Brightens your mood. Spending time outside can help improve your mental outlook and reduce stress. Getting your hands dirty, smelling the soil and connecting with the cycles of life can be meditative activities.

Slims your waistline. Not only does gardening provide you with deliciously healthy food, it’s also a great way to get some exercise. Weeding, trimming and harvesting can be hard work if you keep at it for 30 minutes or more.

Connects you to your family. Getting your family out in the garden is a great way to spend some quality time together, creating something that will benefit all of you.

Provides vitamins and minerals. Fruits, vegetables and herbs are filled with nutrients your body needs to stay healthy. Here’s a sneak peek at just a few of the vitamins and minerals found in common produce items:

Tomatoes are full of fiber, iron, magnesium, niacin, potassium and vitamins A, B6, and C, as well as the antioxidant lycopene.

Basil is a good source of vitamin E (Alpha Tocopherol), riboflavin and niacin. It is also a great source of dietary fiber, vitamins A, B6, C and K, folate, calcium, iron, magnesium, phosphorus, potassium, zinc, copper and manganese.

Blueberries are a good source of dietary fiber, vitamins C and K, manganese and rich in antioxidants.

Kale packs a high iron punch and it’s also high in vitamins A, C and K.

Dill adds flavor and texture to a dinner salad but it also brings vitamins A and C, and lots of iron to the table.

What is your favorite fruit, vegetable or herb to grow in the summertime?

To see more on the health benefits of gardening, check out this video from Lake County's recent community gardening event, Dig Day.

It’s finally here! Summer seems to have arrived and with it warm weather and sunshine. Don’t rush out into the sun just yet though! Sun exposure can damage your skin and increase your risk of skin cancer. That's why it’s so important to protect your skin
from the sun’s harmful rays every day.

How can you protect your skin? What’s the right sunscreen to use? How often should you reapply it? Is sunscreen safe for everyone? NorthShore University HealthSystem has you covered with sun safety tips for adults, kids and babies alike. Click on the image
below to access our full infographic with helpful sun safety tips and then go out and enjoy the summer sun without getting burned.

At some point every woman will go through menopause—a time when the ovaries discontinue the production of estrogen and progesterone
and monthly menstruation stops. For some women this transition can be difficult physically and emotionally.

One important thing for women to understand about menopause is that it is a natural part of the aging process. Although the age at which it starts may vary, it eventually will happen to all women.

Margaret Salamon, MD, Gynecologist at NorthShore, offers the following suggestions for relieving some of the discomforts that menopause
may bring:

Know your hot flash triggers. If you can identify what brings on your hot flashes, you can work on finding ways to reduce them. Common triggers are: coffee, wine, chocolate, and spicy or acidic foods. Additionally, warm temperatures and
stress can be triggers for some women. Keeping a diary for a couple of weeks can help you understand your own triggers.

Make time to exercise. Staying active can help keep your spirits up. Additionally, many women experience a decrease in their hot flashes when they add regular exercise into their routines. The combination of reduced hot flashes and regular
exercise will also help you to sleep better. It’s also important to do exercises that help strengthen your pelvic muscles. Weight-bearing exercise will keep your bones strong.

Revamp your diet. Eating a well-balanced, healthy diet can keep you feeling well during this stage of your life. Be sure you are getting sufficient calcium, iron and fiber on a daily basis. If you can, try to reduce your daily fat, sugar
and salt intake. Additionally, too much caffeine can exacerbate the sleep difficulties you may be having, and it can lead to more irritability. It may also be best to limit your consumption of alcohol.

Reduce your stress. Find time to relax and participate in activities that help you unwind. Do something just for yourself. This might include yoga, reading or meditation.

Get involved! Different cultures view this stage of life in various ways – some have a more positive attitude about it. For example, the Japanese see it as a time to be active in mentoring and guiding others in the community, and not a
time of decline. Consider finding a cause to champion or picking up a new hobby.

Consider hormone therapy. During menopause a woman’s body produces less estrogen and progesterone. This reduction in hormones can lead to various discomforts and symptoms. Those women who have mild symptoms are often able to use natural
products and lifestyle changes, to help with their menopausal symptoms. For others, these methods will not be enough to alleviate their discomfort. There has been a lot of attention to the risks of heart disease and breast cancer related to use of hormones,
but for women who are really incapacitated by the loss of hormones, low doses of hormone replacement, for brief periods of time, can be a good option. As with any treatment option, how you perceive these risks is an individual choice, and you should talk with
your physician about what would be best for you.

What worked for you to help relieve some of the symptoms of menopause?

The warmer temperatures of late spring and summer mean more outdoor family time, from BBQs to pool parties, but it’s
important to make sure that time is safe for you and your kids. Most of us know to practice vigilant sun safety during the hottest months of the year, when the sun’s rays are at their most intense, but sometimes we forget it’s also very important to protect
against dangerous insect bites. Warm temperatures are just as appealing to insects as they are to Chicagoans ready to leave a long winter behind.

Most mosquito bites are irritating but otherwise harmless; however, some mosquitoes can transmit encephalitis and West Nile virus, which can cause severe illness with symptoms like headache, high fever and bodily weakness. Ticks can transmit Lyme disease,
which can be treated if recognized early, so look for flu-like symptoms and possible rashes. Left untreated, Lyme disease can cause joint and muscle pain, fatigue, heart problems and neurological issues.

Felissa Kreindler, MD, Pediatrician at NorthShore, shares her tips for preventing insect bites and protecting against the illnesses
they can cause all summer long:

Don’t apply perfumes and avoid the use of scented soaps. The sweet scents of soaps and perfumes attract some insects.

Stay away from stagnant water and heavily wooded areas. Insects, especially mosquitoes, congregate around pools of water. Deer ticks, which carry Lyme disease, are more likely to be in areas with lots of trees and brush.

Do not use combination sunscreen/insect repellents. Sunscreen needs to be reapplied often but insect repellent should not.

Check DEET concentrations on insect repellents before use. Higher concentrations of DEET protect for longer lengths of time. Choose a concentration based on how long you need to protect yourself. Repellents containing DEET should not be
used on children younger than six months old.

Protect your pets, too. Your four-legged family members can also get diseases from insects. Make sure to bring and use your pet’s flea and tick repellants.

Increasingly more women are waiting until later in life to start families. And while there are many benefits to postponing
motherhood, there are some health risks that increase as a woman ages.

What are the risks? Starting in their mid-30s, women face an increased risk for miscarriage, fetal chromosomal abnormalities, high blood pressure, gestational diabetes, placental abruption, preeclampsia, early labor and are more likely to require a cesarean.

It’s important to remember that these are risks all women, no matter their age, face during pregnancy. While every woman’s pregnancy is unique, older moms-to-be often face some unique challenges. Knowing what challenges might arise and how to reduce your
risk increases the likelihood you’ll enjoy a happy and healthy pregnancy.

Talk to you doctor or midwife before getting pregnant. If you are older than 35 and thinking of starting a family, talk to your doctor or midwife about the current state of your health. He or she can assess your personal risks and recommend
certain lifestyle changes or evaluations to ensure you are at optimal health prior to getting pregnant.

See your doctor or midwife early and regularly. As soon as you think you might be pregnant, see your doctor or midwife. The early stages are very important for any woman. Your doctor or midwife can assess your pregnancy and medical status
in the early months and provide you with information to help guide you through the process. Your doctor or midwife can also discuss your management plan and options during the pregnancy.

Take your vitamins. Again, this is important for any pregnant woman. Prenatal vitamins should contain at least 400 micrograms of folic acid. If you are not yet pregnant but are considering starting a family, start prenatal vitamins or folic
acid now. Getting the recommended amount of folic acid before pregnancy and during the first trimester helps prevent birth defects.

Make healthy lifestyle choices. Pregnancy is an excellent time to embark upon smart lifestyle choices. Moderate exercise—walking, swimming, yoga, stationary bike—for 30-45 minutes daily is encouraged. Make sure to maintain adequate hydration
and avoid overexertion. Cigarettes, alcohol and illicit drugs should be avoided. Over-the-counter medications and herbal medicines should be avoided.

Are you waiting until later to start your family? When did you have your first child?

There are two types of stroke: ischemic, which occur as the result of a blockage inside a blood vessel that supplies blood to the brain, and hemorrhagic, which occur when a blood vessel ruptures and causes bleeding in the brain. When the brain does not
receive a continuous supply of blood, brain cells die. Time is of the utmost importance in the treatment of stroke, and yet many do not call 911 when stroke symptoms arise.
Deborah Lynch, Advance Practice Nurse and Stroke Coordinator at NorthShore, answered our questions on stroke, including signs, risk factors, recovery and more, to raise awareness that stroke is a brain attack and a medical emergency. Don’t
ignore the signs.

What are the signs of a stroke? Are there early signs that might go unnoticed or ignored?
We teach the public to be F.A.S.T., which stands for facial droop, arm and/or leg weakness/numbness, speech/language difficulty and the T is for timing, which means getting medical attention as soon as possible. More subtle signs of stroke
would be similar to the ones listed above but possibly not as pronounced. For instance, if a person notices sudden weakness of his arm and leg on the same side, though he is able to use them, that is still a sign of stroke and it warrants emergent medical
attention. The real problem with stroke and public awareness is there usually is no pain associated with stroke so people wait and see if the symptoms will go away. Time is of essence!

Why is it so important to get medical attention fast?
Brain cells (neurons) die within seconds of not receiving oxygenated blood. The faster a person with stroke symptoms gets to the hospital the better. A person may be candidate for our only FDA-approved treatment for acute stroke: tPA (alteplase). But, this
can only be administered if symptom onset is less than 3-4.5 hours from time of drug administration. Stroke is a medical emergency. Call 911.

What happens after the hospital phase of stroke recovery?
Once the patient is medically stable, they will often go to either a sub-acute rehabilitation facility or an in-patient rehabilitation facility as the next level of care. Both include physical, occupational and speech therapy but in-patient requires that a
patient can tolerate at least three hours of therapy in a given day. Often, patients who have a lot of deficits are unable to withstand this level of therapy at the beginning. In those cases, sub-acute rehab is the next best place. Patients will be able to
get upwards of two hours of therapy a day but it is much more dependent on patient’s endurance. Typical length of stay times are variable and depend on how well or poorly a patient is doing.

After a stroke, how long can patients continue to improve?
Improvement can continue a year from the stroke but improvement is not as dramatic as during the first 3-12 months. That said, people who have language difficulties from stroke have been known to improve for years afterward.

Is a younger stroke patient likely to have a better recovery than someone who is older?
Stroke can happen at any age and when it comes to stroke age is relative. Someone can have a more severe stroke as a younger person than an older person. Usually the younger patients have fewer chronic health issues though. If you are in poor health before
a stroke, it’s more difficult to recover primarily because there is less reserve. That said, I have seen quite large strokes in an elderly population with good outcomes. The brain is a very complex organ and everyone really recovers differently. On the whole,
after a stroke, people improve. Where one can functionally get to remains unknown.

If there is a family history of stroke and high blood pressure, what can you to do prevent stroke.
Regular aerobic exercise and healthy eating are terrific approaches to what we refer to as "primary stroke prevention." Hypertension, or high blood pressure (typically greater than 130/85), is the number one risk factor for stroke. If you do have high blood
pressure, make sure to treat it. Do not delay. Hypertension is a "silent killer.” People usually don't feel any different with high blood pressure.

What’s a “mini stroke”? Can it lead to a more severe stroke?
Mini stroke is a term we in the stroke field would like to do away with. It has been used in the past to refer to
TIA (transient ischemic attack). This is an event with stroke-like symptoms that usually resolves itself within minutes. The problem with this term is that it sounds almost cute and harmless. In actuality, it carries the same risk of future
stroke as an actual stroke. TIAs are definitely warning signs of stroke. We take these events very seriously with the hope of identifying a person's stroke risk factors and reduce them as much as possible to hopefully prevent a stroke in the future. These
preventative measures include lifestyle changes like diet and exercise.

In addition to healthy eating and exercise, is an aspirin regimen recommended after a TIA?
We recommend at least aspirin 81mg (baby aspirin) or plavix 75mg after a person has had a TIA, especially if there is a history of diabetes, unless there is known contraindication.

The importance of a good night’s sleep can’t be overstated and not getting enough can lead to more than simply waking up on the wrong side of
the bed. Prolonged sleep deprivation can raise your risk for serious health problems like heart disease, diabetes and high blood pressure. Sleep isn’t a waste of time; it’s an investment in your health.

The benefits of sleep are many. According to
Thomas Freedom, MD, Neurologist and Program Director of Sleep Medicine at NorthShore, a good night’s rest can improve:

Your happiness. One sleepless night is depressing but multiple sleepless nights might be a symptom of depression. Insomnia and sleep disorders are strongly linked to depression and prolonged sleep deprivation can aggravate already existing
symptoms of depression. Studies have shown that people diagnosed with depression were far more likely to sleep less than six hours a night.

Your looks. It turns out the fountain of youth isn’t a fountain at all. The key to healthy, youthful skin is plenty of rest. When you don’t get enough sleep, the body releases increased amounts of the stress hormone cortisol and excess
cortisol can break down skin collagen— the protein responsible for supple, line-free skin.

Your health. Chronic sleep deprivation is a contributing factor in a number of serious health problems, including heart disease, diabetes and high blood pressure. Those who regularly fail to get enough sleep are at a higher risk for heart
attack, stroke and heart failure. Lack of sleep can also add to your waistline. Sleep loss is linked in an increase in appetite and cravings for high-carbohydrate and high-fat foods.

Your sex life. If the mood never strikes, your sleep schedule could be to blame. Sleep-deprived men and women often report less interest in sex. Lack of sleep leads to lower energy levels, higher stress levels and fatigue, which all have
a negative effect on libido. To spend more time in the sack, spend more time in bed.

Remember that the amount of sleep required varies with each individual, but most adults need approximately 7-8 hours a night.

Do you think you get enough sleep each night? Do you make sleep a priority?

Skin cancer is the most common kind of cancer, accounting for nearly half of all cancers in the U.S. And despite increased awareness of causes,
risk factors and methods of prevention, the rates of skin cancer, including the three major types—basal cell carcinoma, squamous cell carcinoma and melanoma—continue to climb. Due in part to the use of tanning beds, rates of melanoma, the deadliest type of
skin cancer, are especially high in young women in their 20s and 30s.

While prevention should be the priority—limiting exposure to sunlight, using sunscreen and avoiding the use of tanning beds—early detection is the next best thing. If detected early, skin cancer is almost always curable.

Britt Hanson, DO, medical oncology at NorthShore, shares some of her tips for identifying skin cancer, including what you should keep an
eye out for during regular self-checks.

Have a full-body exam done by a physician. Your physician can ensure that your existing moles, spots or freckles are normal or recommend the precautionary removal of any suspicious ones.

Perform monthly self-exams. After a skin examination by a physician, get in the habit of doing monthly self-exams. Use a full-length mirror to examine your moles and freckles, looking for any changes to existing moles or the development
of new ones.

Remember your ABCDEs. If any of the moles on your body show signs of the ABCDEs, see a physician immediately.

Asymmetry: One half does not mirror the other

Border: Edges are jagged, blurred or irregular

Color: Changes in color or if a mole is various shades of tan, brown, black, blue, white or red